Dependent Student Verification Worksheet by qlc15660

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									                                                                                        2009-2010
                                                   Name of Financial Aid Applicant (Please print in BLACK INK)


                                                   Last                            First                    Middle
RETURN TO:                                         Date of Birth:
Cuyamaca College                                                                        Month                    Day            Year
Financial Aid Office
900 Rancho San Diego Parkway                       Social Security Number: ________________________________________________
El Cajon, CA 92019-4369
FAX 619 660-4279 Phone: 619 660-4201


                     DEPENDENT STUDENT VERIFICATION WORKSHEET
 To receive financial aid, you must complete a process called “Verification.” Verification requires you to submit copies of your and your
 parent(s)’ financial documents (signed Federal income tax returns, W-2 forms, etc.) and provide other information and documents to your
 college Financial Aid Office. After a comparison of information on these forms and documents and the information on the FAFSA (Free
 Application for Federal Student Aid), you may need to make corrections using your SAR, or your college may send corrections electronically.
 What you should do:
     Fill out all sections of this form and return it to the campus Financial Aid Office.
     Submit all other required documents to the campus Financial Aid Office.
     Complete this process as soon as possible so that your financial aid won’t be delayed.
     If you have any questions about filling out this worksheet, talk to someone in the Financial Aid Office.

A. Family Information (for persons included in your parents’ household)
    List the people your parent(s) will support between July 1, 2009 and June 30, 2010. Include yourself, your parent(s) (including stepparent)
    even if you don’t live with your parents, and your parent(s)’ dependent children, even if they don’t live with your parent(s), IF (a) your
    parent(s) will provide more than half of their support from July 1, 2009 through June 30, 2010, OR (b) they would be required to give
    parental information when applying for Federal Student Aid). Include other people as part of your household only if they now live with
    your parent(s) and your parents provide more than half of their support AND will continue to provide more than half of their support from
    July 1, 2009 through June 30, 2010.
    Write the names of all household members. Also, write in the name of the college for any household member, excluding your parent(s),
    who will be attending college at least half-time between July 1, 2009 and June 30, 2010, and will be enrolled in a degree, diploma or
    certificate program. If you need more space, attach a separate page.

                                                                                                    Name of College (if half-time
                          Full Name                           Age       Relationship            attendance or more during 2009-2010)
      Student Applicant                                                Self




B. Student’s Tax Forms and Income Information
    B-1     Please submit a signed copy of your Federal tax return (includes the 2008 IRS Forms 1040, 1040A, 1040EZ, a tax return from
            Puerto Rico, or a foreign income tax return). If you did not keep a copy of the tax return, request a copy from your tax preparer
            or a copy of an Internal Revenue Service form that lists tax account information.
               Check here and attach signed Federal tax return.
               Check here if you will not file and are not required to file a 2008 Federal Income Tax Return.
    B-2     If you did not file and are not required to file a 2008 Federal Income Tax Return, list below your employer(s) and any income
            received in 2008, (use the W-2 form or other earnings statements, if available).

              Employer(s)                                                                                                  2008 Amount
                                                                                                                       $
                                                                                                                       $
                                                                                                                       $

                                                     COMPLETE BOTH SIDES

210/DSVW (Rev. 04/14/09, rlq)
                                                                                 2009-2010 Dependent Student Verification Worksheet (Continued)


      B-3       Funds received for child support, other untaxed income (e.g., disability, Military Living Allowance, Workman’s Compensation)
                and any other income not reported on a 2008 Federal tax return. (See Question 47 and Worksheet of the Free Application for
                Federal Student Aid (FAFSA) for help in identifying income (if any) to be reported.)

                                                              Source(s) of Untaxed Income                                                                      2008 Amount
                                                                                                                                                           $
                                                                                                                                                           $
                                                                                                                                                           $

C. Parents’ Tax Forms and Income Information
      C-1       Please submit a signed copy of your parents’ Federal income tax return (includes the 2008 IRS Forms 1040, 1040A, 1040EZ, a
                tax return from Puerto Rico, or a foreign income tax return). If you did not keep a copy of the tax return, request a copy from
                your tax preparer or a copy of an Internal Revenue Service form that lists tax account information.
                      Check here and attach signed Federal tax return.
                      Check here if your parent(s) will not file and are not required to file a 2008 Federal Income Tax Return.
      C-2       If your parent(s) did not file and are not required to file a 2008 Federal Income Tax Return, list below your parents’ employer(s)
                and any income received in 2008, (use the W-2 form or other earnings statements, if available).

                   Employer(s)                                                                                                                                 2008 Amount
                                                                                                                                                           $
                                                                                                                                                           $
                                                                                                                                                           $
      C-3       Funds received for child support, other untaxed income (e.g., disability, Military Living Allowance, Workman’s Compensation)
                and any other income not reported on a 2008 Federal tax return. (See Question 95 and Worksheet of the Free Application for
                Federal Student Aid (FAFSA) for help in identifying income (if any) to be reported.)

                                                              Source(s) of Untaxed Income                                                                      2008 Amount
                                                                                                                                                           $
                                                                                                                                                           $
                                                                                                                                                           $

D. Signatures
      By signing this worksheet, we certify that all the information reported to qualify for federal student aid is complete and correct (at least
      one parent must sign).

                             WARNING: If you purposely give false or misleading information on this worksheet,
                                             you may be fined, sentenced to jail, or both.



      Signature of Applicant                                                        Date


      Signature of Applicant’s Father/Stepfather                                    Date            Signature of Applicant’s Mother/Stepmother                                    Date

             DO NOT MAIL THIS WORKSHEET TO THE US DEPARTMENT OF EDUCATION.
   TAKE IT TO YOUR COLLEGE FINANCIAL AID OFFICE. DON’T FORGET TO SIGN YOUR TAX FORMS.
                                                                         California Information Privacy Act
State and federal laws protect an individual’s right to privacy regarding information pertaining to oneself. The California Information Practices Act of 1977 requires the following
information be provided to financial aid applicants who are asked to supply information about themselves. The principal purpose for requesting information on this form is to
determine your eligibility for financial aid. The Chancellor’s Office policy and the policy of the community college to which you are applying for aid authorize maintenance of this
information. Failure to provide such information will delay and may even prevent your receipt of financial assistance. This form’s information may be transmitted to other state
agencies and the federal government if required by law. Individuals have the right of access to records established from information furnished on this form as it pertains to them.
The officials responsible for maintaining the information contained on this form are the financial aid administrators at the institutions to which you are applying for financial aid.
The SSN may be used to verify your identity under record keeping systems established prior to January 1, 1975. If your college requires you to provide an SSN and you have
questions, you should ask the financial aid officer at your college for further information. The Chancellor’s Office and the California community colleges, in compliance with
federal and state laws, do not discriminate on the basis of race, religion, color, national origin, gender, age, disability, medical condition, sexual orientation, domestic partnership or
any other legally protected basis. Inquiries regarding these policies may be directed to the financial aid office of the college to which you are applying.




210/DSVW (Rev. 04/14/09, rlq)

								
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